Biomechanical Effect of L4 -L5 Intervertebral Disc Degeneration on the Lower Lumbar Spine: A Finite Element Study

Xin-Yi Cai, Meng-Si Sun, Yun-Peng Huang, Zi-Xuan Liu, Chun-Jie Liu, Cheng-Fei Du, Qiang Yang, Xin-Yi Cai, Meng-Si Sun, Yun-Peng Huang, Zi-Xuan Liu, Chun-Jie Liu, Cheng-Fei Du, Qiang Yang

Abstract

Objective: To ascertain the biomechanical effects of a degenerated L4 -L5 segment on the lower lumbar spine through a comprehensive simulation of disc degeneration.

Methods: A three-dimensional nonlinear finite element model of a normal L3 -S1 lumbar spine was constructed and validated. This normal model was then modified such that three degenerated models with different degrees of degeneration (mild, moderate, or severe) at the L4 -L5 level were constructed. While experiencing a follower compressive load (500 N), hybrid moment loads were applied to all models to determine range of motion (ROM), intradiscal pressure (IDP), maximum von Mises stress in the annulus, maximum shear stress in the annulus, and facet joint force.

Results: As the degree of disc degeneration increased, the ROM of the L4 -L5 degenerated segment declined dramatically in all postures (flexion: 5.79°-1.91°; extension: 5.53°-2.62°; right lateral bending: 4.47°-1.46°; left lateral bending: 4.86°-1.61°; right axial rotation: 2.69°-0.74°; left axial rotation: 2.69°-0.74°), while the ROM in adjacent segments increased (1.88°-8.19°). The largest percent decrease in motion of the L4 -L5 segment due to disc degeneration was in right axial rotation (75%), left axial rotation (69%), flexion (67%), right lateral bending (67%), left lateral bending right (67%), and extension (53%). The change in the trend of the IDP was the same as that of the ROM. Specifically, the IDP decreased (flexion: 0.592-0.09 MPa; extension: 0.678-0.334 MPa; right lateral bending: 0.498-0.205 MPa; left lateral bending: 0.523-0.272 MPa; right axial rotation: 0.535-0.246 MPa; left axial rotation: 0.53-0.266 MPa) in the L4 -L5 segment, while the IDP in adjacent segments increased (0.511-0.789 MPa). The maximum von Mises stress and maximum shear stress of the annulus in whole lumbar spine segments increased (L4 -L5 segment: 0.413-2.626 MPa and 0.412-2.783 MPa, respectively; adjacent segment of L4 -L5 : 0.356-1.493 MPa and 0.359-1.718 MPa, respectively) as degeneration of the disc progressively increased. There was no apparent regularity in facet joint force in the degenerated segment as the degree of disc degeneration increased. Nevertheless, facet joint forces in adjacent healthy segments increased as the degree of disc degeneration increased (extension: 49.7-295.3 N; lateral bending: 3.5-171.2 N; axial rotation: 140.2-258.8 N).

Conclusion: Degenerated discs caused changes in the motion and loading pattern of the degenerated segments and adjacent normal segments. The abnormal load and motion in the degenerated models risked accelerating degeneration in the adjacent normal segments. In addition, accurate simulation of degenerated facet joints is essential for predicting changes in facet joint loads following disc degeneration.

Keywords: Biomechanical effect; Disc degeneration; Finite element; Lower lumbar spine.

© 2020 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Figures

Figure 1
Figure 1
Three‐dimensional nonlinear finite element model of a normal lumbar spine (L3–S1).
Figure 2
Figure 2
Anterior views of a normal and three degenerative three‐dimensional nonlinear finite element models of the lumbar spine (L3–S1). (A) Normal model: material properties (no degeneration), normal disc height (no degeneration), no anterior osteophytes. (B) Mild degeneration: material properties (mild degeneration), 20% reduction in disc height, anterior osteophyte size representing 10%. (C) Moderate degeneration: material properties (moderate degeneration), 40% reduction in disc height, anterior osteophyte size representing 20%. (D) Severe degeneration: material properties (severe degeneration), 60% reduction in disc height, anterior osteophytes size representing 30%.
Figure 3
Figure 3
Sagittal views of a normal and three degenerative three‐dimensional nonlinear finite element models of the lumbar spine (L3–S1). (A) Normal model: the material properties (no degeneration), normal disc height (no degeneration), no anterior osteophytes. (B) Mild degeneration: material properties (mild degeneration), 20% reduction in disc height, anterior osteophyte size representing 10%. (C) Moderate degeneration: material properties (moderate degeneration), 40% reduction in disc height, anterior osteophyte size representing 20%. (D) Severe degeneration: material properties (severe degeneration), 60% reduction in disc height, anterior osteophytes size representing 30%.
Figure 4
Figure 4
Schematic diagram of the vertebral sagittal diameter and anterior osteophyte dimensions.
Figure 5
Figure 5
Calibration results of seven major ligaments of the lumbar spine finite element model: (A) anterior longitudinal ligament (ALL), capsular ligament (CL), intertransverse ligament (ITL), and posterior longitudinal ligament (PLL); and (B) flaval ligament (FL), interspinous ligament (ISL), and supraspinal ligament (SSL).
Figure 6
Figure 6
Comparison of finite predicted data of the normal model (range of motion and disc compression of each segment) and experimental data of clinical specimens by Renner et al.50.
Figure 7
Figure 7
Range of motion (ROM) in normal and degenerated lumbar spine finite element (FE) models in six directions (LAR, left axial rotation; LB, left bending; RAR, right axial rotation; RB, right bending). (A) ROM of the L3–L4 segment in all lumbar spine FE models. (B) ROM of the L4–L5 segment in all lumbar spine FE models. (C) ROM of the L5–S1 segment in all lumbar spine FE models. (D) Percentage change in ROM of the L4–L5 degenerated segment with respect to L4–L5 segments of the normal model.
Figure 8
Figure 8
Intradiscal pressure (IDP) of the normal and degenerated lumbar spine finite element (FE) models in six directions. (A) IDP of the L3–L4 segment in all lumbar spine FE models. (B) IDP of the L4–L5 segment in all lumbar spine FE models. (C) IDP of the L5–S1 segment in all lumbar spine FE models.
Figure 9
Figure 9
Maximum von Mises and shear stress in the annulus of the normal and degenerated lumbar spine finite element (FE) models in six directions. (A) Maximum von Mises stress in the annulus of the L3–L4 segment in all lumbar spine FE models. (B) Maximum von Mises stress in the annulus of the L4–L5 segment in all lumbar spine FE models. (C) Maximum von Mises stress in the annulus of the L5–S1 segment in all lumbar spine FE models. (D) Maximum shear stress in the annulus of the L3–L4 segment in all lumbar spine FE models. (E) Maximum shear stress in the annulus of the L4–L5 segment in all lumbar spine FE models. (F) Maximum shear stress in the annulus of the L5–S1 segment in all lumbar spine FE models.
Figure 10
Figure 10
Facet joint force in normal and degenerated lumbar spine finite element (FE) models in six directions (L, left; R, Right). (A) Facet joint force of the L3–L4 segment in all lumbar spine FE models. (B) Facet joint force of the L5–S1 segment in all lumbar spine FE models. (C) Facet joint force of the L4‐L5 segment in all lumbar spine FE models.

References

    1. Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it?. Spine (Phila Pa 1976), 2006, 31: 2151–2161.
    1. Stokes IA, Iatridis JC. Mechanical conditions that accelerate intervertebral disc degeneration: overload versus immobilization. Spine (Phila Pa 1976), 2004, 29: 2724–2732.
    1. Iatridis JC, Setton LA, Weidenbaum M, Mow VC. Alterations in the mechanical behavior of the human lumbar nucleus pulposus with degeneration and aging. J Orthop Res, 1997, 15: 318–322.
    1. Wilke HJ, Rohlmann F, Neidlinger‐Wilke C, Werner K, Claes L, Kettler A. Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: part I. Lumbar spine. Eur Spine J, 2006, 15: 720–730.
    1. Waris E, Eskelin M, Hermunen H, Kiviluoto O, Paajanen H. Disc degeneration in low back pain: a 17‐year follow‐up study using magnetic resonance imaging. Spine (Phila Pa 1976), 2007, 32: 681–684.
    1. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord, 2000, 13: 205–217.
    1. Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976), 2005, 30: 1441–1447.
    1. Von Forell GA, Stephens TK, Samartzis D, Bowden AE. Low back pain: a biomechanical rationale based on "patterns" of disc degeneration. Spine (Phila Pa 1976), 2015, 40: 1165–1172.
    1. Machado GC, Maher CG, Ferreira PH, et al Trends, complications, and costs for hospital admission and surgery for lumbar spinal stenosis. Spine (Phila Pa 1976), 2017, 42: 1737–1743.
    1. Gunzburg R, Parkinson R, Moore R, et al A cadaveric study comparing discography, magnetic resonance imaging, histology, and mechanical behavior of the human lumbar disc. Spine (Phila Pa 1976), 1992, 17: 417–426.
    1. Wang K, Jiang C, Wang L, Wang H, Niu W. The biomechanical influence of anterior vertebral body osteophytes on the lumbar spine: a finite element study. Spine J, 2018, 18: 2288–2296.
    1. Schmidt H, Kettler A, Rohlmann A, Claes L, Wilke HJ. The risk of disc prolapses with complex loading in different degrees of disc degeneration ‐ a finite element analysis. Clin Biomech (Bristol, Avon), 2007, 22: 988–998.
    1. Johansson MS, Jensen Stochkendahl M, Hartvigsen J, Boyle E, Cassidy JD. Incidence and prognosis of mid‐back pain in the general population: a systematic review. Eur J Pain, 2017, 21: 20–28.
    1. Luoma K, Riihimaki H, Luukkonen R, Raininko R, Viikari‐Juntura E, Lamminen A. Low back pain in relation to lumbar disc degeneration. Spine (Phila Pa 1976), 2000, 25: 487–492.
    1. Kettler A, Rohlmann F, Ring C, Mack C, Wilke HJ. Do early stages of lumbar intervertebral disc degeneration really cause instability? Evaluation of an in vitro database. Eur Spine J, 2011, 20: 578–584.
    1. Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A. Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine (Phila Pa 1976), 1994, 19: 1371–1380.
    1. Fujiwara A, Lim TH, An HS, et al The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine (Phila Pa 1976), 2000, 25: 3036–3044.
    1. Fujiwara A, Tamai K, An HS, et al The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine. J Spinal Disord, 2000, 13: 444–450.
    1. Hicks GE, Morone N, Weiner DK. Degenerative lumbar disc and facet disease in older adults: prevalence and clinical correlates. Spine (Phila Pa 1976), 2009, 34: 1301–1306.
    1. McNally DS, Adams MA. Internal intervertebral disc mechanics as revealed by stress profilometry. Spine (Phila Pa 1976), 1992, 17: 66–73.
    1. Pollintine P, Dolan P, Tobias JH, Adams MA. Intervertebral disc degeneration can lead to "stress‐shielding" of the anterior vertebral body: a cause of osteoporotic vertebral fracture?. Spine (Phila Pa 1976), 2004, 29: 774–782.
    1. Rohlmann A, Zander T, Schmidt H, Wilke HJ, Bergmann G. Analysis of the influence of disc degeneration on the mechanical behaviour of a lumbar motion segment using the finite element method. J Biomech, 2006, 39: 2484–2490.
    1. Park WM, Kim YH, Lee S. Effect of intervertebral disc degeneration on biomechanical behaviors of a lumbar motion segment under physiological loading conditions. J Mech Sci Technol, 2013, 27: 483–489.
    1. Galbusera F, Schmidt H, Neidlinger‐Wilke C, Gottschalk A, Wilke HJ. The mechanical response of the lumbar spine to different combinations of disc degenerative changes investigated using randomized poroelastic finite element models. Eur Spine J, 2011, 20: 563–571.
    1. Jackson AR, Huang CY, Gu WY. Effect of endplate calcification and mechanical deformation on the distribution of glucose in intervertebral disc: a 3D finite element study. Comput Methods Biomech Biomed Engin, 2011, 14: 195–204.
    1. Little JP, Adam CJ, Evans JH, Pettet GJ, Pearcy MJ. Nonlinear finite element analysis of anular lesions in the L4/5 intervertebral disc. J Biomech, 2007, 40: 2744–2751.
    1. Tang S, Rebholz BJ. Does anterior lumbar interbody fusion promote adjacent degeneration in degenerative disc disease? A finite element study. J Orthop Sci, 2011, 16: 221–228.
    1. Ruberté LM, Natarajan RN, Andersson GB. Influence of single‐level lumbar degenerative disc disease on the behavior of the adjacent segments–a finite element model study. J Biomech, 2009, 42: 341–348.
    1. Park WM, Kim K, Kim YH. Effects of degenerated intervertebral discs on intersegmental rotations, intradiscal pressures, and facet joint forces of the whole lumbar spine. Comput Biol Med, 2013, 43: 1234–1240.
    1. Wu Y, Wang Y, Wu J, et al Study of double‐level degeneration of lower lumbar spines by finite element model. World Neurosurg, 2016, 86: 294–299.
    1. Du C, Mo Z, Tian S, et al Biomechanical investigation of thoracolumbar spine in different postures during ejection using a combined finite element and multi‐body approach. Int J Numer Method Biomed Eng, 2014, 30: 1121–1131.
    1. Du CF, Yang N, Guo JC, Huang YP, Zhang C. Biomechanical response of lumbar facet joints under follower preload: a finite element study. BMC Musculoskelet Disord, 2016, 17: 126–138.
    1. Keaveny TM, Buckley JM. Biomechanics of vertebral bone In: Kurtz SM, Edidin AA, eds. Spine Technology Handbook. New York: Academic Press, 2006; 63–98.
    1. Simon P, Espinoza Orias AA, Andersson GB, An HS, Inoue N. In vivo topographic analysis of lumbar facet joint space width distribution in healthy and symptomatic subjects. Spine (Phila Pa 1976), 2012, 37: 1058–1064.
    1. Woldtvedt DJ, Womack W, Gadomski BC, Schuldt D, Puttlitz CM. Finite element lumbar spine facet contact parameter predictions are affected by the cartilage thickness distribution and initial joint gap size. J Biomech Eng, 2011, 133: 061009.
    1. Pooni JS, Hukins DW, Harris PF, Hilton RC, Davies KE. Comparison of the structure of human intervertebral discs in the cervical, thoracic and lumbar regions of the spine. Surg Radiol Anat, 1986, 8: 175–182.
    1. Ayturk UM, Garcia JJ, Puttlitz CM. The micromechanical role of the annulus fibrosus components under physiological loading of the lumbar spine. J Biomech Eng, 2010, 132: 061007.
    1. Shirazi‐Adl A, Ahmed AM, Shrivastava SC. Mechanical response of a lumbar motion segment in axial torque alone and combined with compression. Spine (Phila Pa 1976), 1986, 11: 914–927.
    1. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic‐resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am, 1990, 72: 403–408.
    1. Elfering A, Semmer N, Birkhofer D, Zanetti M, Hodler J, Boos N. Risk factors for lumbar disc degeneration: a 5‐year prospective MRI study in asymptomatic individuals. Spine (Phila Pa 1976), 2002, 27: 125–134.
    1. McMillan DW, McNally DS, Garbutt G, Adams MA. Stress distributions inside intervertebral discs: the validity of experimental ‘tress profilometry’. Proc Inst Mech Eng H, 1996, 210: 81–87.
    1. Benneker LM, Heini PF, Anderson SE, Alini M, Ito K. Correlation of radiographic and MRI parameters to morphological and biochemical assessment of intervertebral disc degeneration. Eur Spine J, 2005, 14: 27–35.
    1. Kumaresan S, Yoganandan N, Pintar FA, Maiman DJ, Goel VK. Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation. J Orthop Res, 2001, 19: 977–984.
    1. He X, Liang A, Gao W, et al The relationship between concave angle of vertebral endplate and lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2012, 37: 1068–1073.
    1. Cai XY, Sang D, Yuchi CX, et al Using finite element analysis to determine effects of the motion loading method on facet joint forces after cervical disc degeneration. Comput Biol Med, 2020, 116: 103519 10.1016/j.compbiomed.2019.103519.
    1. Wang K, Wang L, Deng Z, Jiang C, Niu W, Zhang M. Influence of passive elements on prediction of intradiscal pressure and muscle activation in lumbar musculoskeletal models. Comput Methods Programs Biomed, 2019, 177: 39–46.
    1. Du CF, Guo JC, Huang YP, Fan YB. A new method for determining the effect of follower load on the range of motions in the lumbar spine. In: World Congress on Medical Physics and Biomedical Engineering, June 7–12, 2015, Toronto, Canada, 2015; 326–329.
    1. Schmidt H, Heuer F, Simon U, et al Application of a new calibration method for a three‐dimensional finite element model of a human lumbar annulus fibrosus. Clin Biomech (Bristol, Avon), 2006, 21: 337–344.
    1. Schmidt H, Heuer F, Drumm J, Klezl Z, Claes L, Wilke HJ. Application of a calibration method provides more realistic results for a finite element model of a lumbar spinal segment. Clin Biomech (Bristol, Avon), 2007, 22: 377–384.
    1. Renner SM, Natarajan RN, Patwardhan AG, et al Novel model to analyze the effect of a large compressive follower pre‐load on range of motions in a lumbar spine. J Biomech, 2007, 40: 1326–1332.
    1. Wang IC, Ueng SW, Lin SS, et al Effect of hyperbaric oxygenation on intervertebral disc degeneration: an in vitro study with human lumbar nucleus pulposus. Spine (Phila Pa 1976), 2011, 36: 1925–1931.
    1. Schmidt H, Heuer F, Wilke HJ. Dependency of disc degeneration on shear and tensile strains between annular fiber layers for complex loads. Med Eng Phys, 2009, 31: 642–649.
    1. Mirza SK, White AA 3rd. Anatomy of intervertebral disc and pathophysiology of herniated disc disease. J Clin Laser Med Surg, 1995, 13: 131–142.
    1. Raj PP. Intervertebral disc: anatomy‐physiology‐pathophysiology‐treatment. Pain Pract, 2008, 8: 18–44.
    1. Yang KH, King AI. Mechanism of facet load transmission as a hypothesis for low‐back pain. Spine (Phila Pa 1976), 1984, 9: 557–565.
    1. Butler D, Trafimow JH, Andersson GB, McNeill TW, Huckman MS. Discs degenerate before facets. Spine (Phila Pa 1976), 1990, 15: 111–113.
    1. Lee JC, Choi SW. Adjacent segment pathology after lumbar spinal fusion. Asian Spine J, 2015, 9: 807–817.
    1. Videbaek TS, Egund N, Christensen FB, GretheJurik A, Bunger CE. Adjacent segment degeneration after lumbar spinal fusion: the impact of anterior column support: a randomized clinical trial with an eight‐ to thirteen‐year magnetic resonance imaging follow‐up. Spine (Phila Pa 1976), 2010, 35: 1955–1964.
    1. Wai EK, Santos ER, Morcom RA, Fraser RD. Magnetic resonance imaging 20 years after anterior lumbar interbody fusion. Spine (Phila Pa 1976), 2006, 31: 1952–1956.
    1. Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI‐TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg, 2015, 1: 2–18.
    1. Sohn HM, You JW, Lee JY. The relationship between disc degeneration and morphologic changes in the intervertebral foramen of the cervical spine: a cadaveric MRI and CT study. J Korean Med Sci, 2004, 19: 101–106.
    1. Colombini A, Lombardi G, Corsi MM, Banfi G. Pathophysiology of the human intervertebral disc. Int J Biochem Cell Biol, 2008, 40: 837–842.
    1. Massey CJ, van Donkelaar CC, Vresilovic E, Zavaliangos A, Marcolongo M. Effects of aging and degeneration on the human intervertebral disc during the diurnal cycle: a finite element study. J Orthop Res, 2012, 30: 122–128.
    1. Galbusera F, Mietsch A, Schmidt H, Wilke HJ, Neidlinger‐Wilke C. Effect of intervertebral disc degeneration on disc cell viability: a numerical investigation. Comput Methods Biomech Biomed Engin, 2013, 16: 328–337.
    1. Hadjipavlou AG, Tzermiadianos MN, Bogduk N, Zindrick MR. The pathophysiology of disc degeneration: a critical review. J Bone Joint Surg Br, 2008, 90: 1261–1270.
    1. Roughley PJ, Melching LI, Heathfield TF, Pearce RH, Mort JS. The structure and degradation of aggrecan in human intervertebral disc. Eur Spine J, 2006, 15: 326–332.
    1. Zhu R, Niu WX, Wang ZP, et al The effect of muscle direction on the predictions of finite element model of human lumbar spine. Biomed Res Int, 2018, 2018: 4517471.

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